Liver transplantation in patients with chronic liver disease after emergency hospital admission in England: a nationwide study using linked datasets

Objective People with chronic liver disease (CLD) are often admitted to hospital as an emergency, when survival is poor. Liver transplantation (LT) is an intervention with major survival benefit. We assessed use of LT following first emergency admission (FEA) for CLD in England. Design/methods We analysed national data including patients with an FEA for CLD between 2012 and 2019. Competing risks models were used to estimate adjusted subdistribution HRs (sHRs) of LT by socio-demographic, clinical and geographical factors. Results 526 (0.64%) of 82 402 patients underwent LT within 1 year, while 31 155 (37.8%) died. Individuals from the most deprived quintile of neighbourhoods had half the LT rate of the least deprived quintile (sHR 0.52, 95% CI 0.38 to 0.70). Patients presenting to hospital with an LT unit were nearly four times as likely to have LT (sHR 3.80, 95% CI 1.31 to 10.98). Patients with metabolic disease were nearly five times (sHR 5.05, 95% CI 3.60 to 7.08) and those with autoimmune disease six times (sHR 6.25, 95% CI 4.87 to 8.13) as likely to have LT as those with alcohol-related liver disease. LT rates varied across nine English regions from 1.0% in the East to 0.45% in the North East. Conclusion LT is rarely used after FEA for CLD, with marked socioeconomic and regional differences. 1-year mortality without LT is high. LT use is by far the lowest in patients with alcohol-related liver disease. Action is needed to increase LT rates overall, address inequities, optimise life-saving care in hospital and address modifiable risk factors, including alcohol use, after discharge.